We have two special guests on the podcast this week: Paul Jones and Dan Finnigan are Canadian family doctors with extra training in emergency and obstetrics.
The guys have created a mobile obstetric app called “Simply Obstetrics”. Check it out here. In part one of the podcast we discuss the perils of rural and remote obstetrics and how the app can come in handy for those isolated or “occasional” birth attendants.
In part two we get into the meaty clinical topic of episiotomies and protection of the perineum.
Our top take home messages:
- Episiotomies should be used selectively not routinely, as the use of routine episiotomy results in increased risk of major sphincter injury
- The mediolateral approach is associated with less risk of sphincter injury compared to midline approach
- The threshold for cutting an episiotomy should be much lower with instrumental deliveries, particularly forceps (NNT = 7)
- We prefer the use of “hands on” technique for delivery, with controlled delivery of the fetal head and warm compresses to the perineum
References & Resources
Cochrane Review (2009) – Episiotomy for Vaginal Birth
Cochrane Review (2011) – Perineal Techniques During the Second Stage of Labour for Reducing Perineal Trauma
Dixon, O&G Magazine (Autumn 2014) – The Unkindest Cut?
Eogan et al, BJOG (Feb 2006) – Does the Angle of Episiotomy Affect the Incidence of Anal Sphincter Injury?
Jansova et al, International Urogynecology Journal (September 2014) – Modeling Manual Perineal Protection During Vaginal Delivery
Check out Paul’s Blog – A Life in the Woods and more info about the Simply Obstetrics app
A great talk, especially the “hand on” technique at reducing the risk of tears. I also try to avoid the birth stool at all cost. Seems to make the tears worse and that is not just my opinion. Some evidence on Medline: http://www.ncbi.nlm.nih.gov/pubmed/22884894 [Odds Ratio 1.40 [1.12-1.75]
Not in favour of using the expression I am going to make a “nick” to describe an episiotomy. I may nick myself shaving, or nick off a skin tag. I generally don’t need to sew up a “nick”. I agree there should be a time antenatally when this is discussed but I would never call an episiotomy a nick. When someone goes home and has looks in the mirror at her perineum and see what I described as a “nick” I think she would deservedly be cranky.
I also find that non-third tears are easier to repair than episiotomy, whether my own or the midwife’s
Downloaded the app to check it out.